Reflections on Pediatric Surgery

Ok, so sometimes I ramble. I can't think of a good forum for it right now, and I'm kind of in a wierd mood right now, and I feel like getting some thoughts off my chest.

I don't get much time to think while I'm at the hospital. I'm usually so busy that I just get to react. "The patient's lungs are crackling. That's bad because it could mean a pneumonia. I need to call the resident. I need to get a chest X-ray. I need to write it in the patient's chart." That sort of thing goes on all day.

When I come home, the last thing I want to do is think about work, so I'll go to the pool and swim, or play a mindless video game. Or spin poi if the weather is cooperative.

But sometimes, I get to thinking and I need to organize my thoughts. So here goes.

In the old days, when kids got sick, they often died. A kid born with what is now an easily corrected problem (a cleft lip, a hernia, a bowel obstruction, etc) had no chance back then. How many of us would not be here today if not for modern medicine? I sure wouldn't be.

But I've dealt with some sick kids and some really sick kids. The sick ones are easier. Most of them were healthy and got sick. We can fix that. But the really sick kids were born sick. And it's sad to see some of them. Bed-ridden, unable to interact with others, trapped in a life of grunts, diapers, and painful contractions and seizures.

And I see it starting every day. With recent advances in the care of infants, we're keeping more kids alive today who would have died than ever before. But the ones we're keeping alive now wind up severely disabled.

And I wonder. Isn't that cruel? Shouldn't we just keep the baby comortable and let nature do its thing when we don't think the long-term outcome will be good? Why do we fight so hard?

I've almost forgotten what a healthy baby looks like at this point. When I think "baby" I think of a small, skinny kid in an ICU bed wired up like an underground system. I saw a real, healthy baby today in the hospital. His mom worked there. He was beautiful. I didn't have to examine him constantly and write down his vitals. He smiled and drooled at me. I didn't have to worry about his urine output and sodium levels. He was awake, alert, and made eye-contact with me.

So why do I love pediatrics so much? Shouldn't I hate it since I hate seeing sick kids? Why do I jump out of bed every morning excited to see the kids? Why am I excited to see death and destruction like I do?

And yet it tugs at my heartstrings. Yesterday, a pretty sick 5-year-old girl looked up at me and wimpered "I can't breathe. I'm scared I'm gonna die." And my heart just melted to a puddle of goo. All I could say was "Oh ho, honey, we won't let you die!" I felt so horrible that she felt that way. It must be awful to be 5 and terrified you're going to die. It must have been more awful before there were doctors.

But did I make her better? Did we? We can't figure out why she keeps taking oxygen to keep her oxygen saturations up. We can't figure out what's wrong with her other than the fact that the numbers are wrong and yet she's feeling great today.

I love working with the otherwise healthy ones. They're easy. They're happy. They make me happy. I've done something to help someone. But with the really sick ones, I wonder what the hell I'm doing and if I'm really helping anyone. It's so frustrating because I feel like it's a moral defect that I can't automatically see the value of every human life.

But I love it. And on some deep level, I believe in what I'm doing.

[ 02. November 2003, 11:57: Message edited by: Lïghtnïng ]

-Mike

Certified Mad Doctor and HoP High Priest of Nutella

A buckuht n a hooze! -Valura

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